Pfeifer J, Reissman P, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Dis Colon Rectum. 1995 Nov;38(11):1224-6. doi: 10.1007/BF02048343.
This report stresses the importance of local complications caused by ergotamine abuse for the treatment of migraine headaches.
We present an unusual case of a complex rectovaginal fistula (RVF) caused by long-term ergotamine suppository abuse.
A 39-year-old female was referred after she had undergone a transverse colostomy for temporary fecal diversion. Evaluation, including proctoscopy, gastrograffin enema, vaginogram, and pelvic computerized tomography revealed a RVF 6 cm proximal to the dentate line with distal rectal stricture. Surgical intervention included take down of the transverse colostomy with reanastomosis, proctectomy with excision of the fistula, creation of a colonic "J-pouch" with a coloanal anastomosis, and construction of a temporary loop ileostomy. The patient had an uneventful recovery, and her ileostomy was closed three months later. Pathologic examination of the surgical specimen failed to reveal any specific etiology of the RVF. However, her ten-year use of up to five ergotamine suppositories per day for migraine treatment is associated with a local ischemic effect. Pathophysiology of this rare cause of RVF and the surgical procedure are discussed.
If evidence of any side effects of ergotamine suppositories is seen, early discontinuation of the drug should be considered to avoid complications such as RVF and/or strictures.
本报告强调麦角胺滥用所致局部并发症在偏头痛治疗中的重要性。
我们报告一例因长期滥用麦角胺栓剂导致复杂直肠阴道瘘（RVF）的罕见病例。
一名39岁女性在接受横结肠造口术进行临时粪便改道后前来就诊。包括直肠镜检查、泛影葡胺灌肠、阴道造影和盆腔计算机断层扫描在内的评估显示，在齿状线近端6厘米处存在直肠阴道瘘，并伴有直肠远端狭窄。手术干预包括拆除横结肠造口并重新吻合、切除瘘管的直肠切除术、通过结肠肛管吻合术创建结肠“J袋”以及构建临时回肠造口术。患者恢复顺利，三个月后回肠造口关闭。手术标本的病理检查未发现直肠阴道瘘的任何特定病因。然而，她为治疗偏头痛每天使用多达五枚麦角胺栓剂达十年之久，这与局部缺血效应有关。本文讨论了这种罕见的直肠阴道瘘病因的病理生理学及手术过程。
如果发现麦角胺栓剂有任何副作用的迹象，应考虑尽早停药以避免诸如直肠阴道瘘和/或狭窄等并发症。
